Factors Associated with Decision Making about Family Planning Use by Refugee and Host Population in Adjumani District, West Nile, Uganda; A Cross Sectional Study

Introduction: Uganda currently hosts an estimated 1.5 million refugees. The majority, (60.5%, n = 964,960) come from South Sudan. This study investigated factors associated with decision making for Family Planning (FP) use among host and refugee populations in Adjumani district, Uganda. Methods: This was a comparative cross sectional study conducted in three refugee settlements of Pagirinya, Nyumazi and Mirieyi, and the surrounding host communities in Adjumani district. A total of 1,307 respondents, comprising 661 refugees and 646 host household heads were randomly selected and interviewed using multi stage cluster sampling. Quantitative data were collected using structured questionnaires with Open Data Kit (ODK). Data were analyzed using STATA V.14 C. Multivariable logistic regression was carried out to establish the factors associated with decision making to use family planning. Results: The study found that modern contraceptive prevalence rate (mCPR) was 28.6% and 28.4% amongst host and refugees respectively. The factors significantly associated with decision to use FP amongst host population included religion, Anglicans were 6.2 times more likely to use FP compared to Catholics, AOR = 6.21, 95% CI [1.11-34.57]. Respondents who made joint decisions were nearly three times more likely to use modern FP methods compared to those who made personal decision, AOR = 2.69, 95% CI [0.89-138.39]. Similarly, amongst refugees, Anglicans were more likely to use modern family planning methods compared to Catholic refugees; AOR= 5, 95% CI [4.75-13.23] and AOR= 7.05 95% CI [2.8-44.88] respectively; respondents who attained tertiary education. AOR = 2.17 95% CI [0.11-43.08] and those who made joint decision; AOR 6.43 95% CI [1.78-16.08] were more likely to use modern FP methods. The key barriers to decision making regarding modern FP use by the host, included harassment of women who did not consult their significant others (AOR = 0.07, 95% CI [0.01-0.79] and separation/divorce (AOR = 0.03, 95% CI [0.00-0.35]. Whereas amongst the refugees, main reasons for not using FP included not wanting to use FP” [45.8%], wanting to become pregnant [6.8%], and fear of side effects [5.8%]. Conclusions: Use of modern family planning is low amongst both refugee and host populations in Adjumani district. The main factors associated with decision to use FP amongst both refugee and host populations include religion, level of education and husband’s approval. Main reasons for not using modern FP methods include fear of side effects and not wanting to use FP by both host and refugees respectively. There is need to sensitize both communities about the benefits of FP and promote male involvement including couple counseling at community level.